Health care in Costa Rica is available to the entire population through the
coordination of three main bodies: the Ministry of Health, the Institute of
Social Security (CCSS) and the National Institute of Social Security. In 1982 a
national formulary was established, containing 362 generic drugs. Each health
care institution chose its own list from this formulary, and the formulary is
updated periodically based on the WHO selection criteria of efficacy, security,
cost/risk benefit, and combinations only in certain conditions. Strategies have
been developed to promote rational drug use, including continued education for
doctors and pharmacists, distribution of objective and current information to
doctors and pharmacists, studies on consumption data, increased training and
better packaging to improve acceptance of drugs from consumers. In addition, a
voluntary system of notification of adverse drug reactions has been in place
since 1986. The Monitor article emphasized Costa Rica as an example for
positive change with limited resources.